右美托咪定在幼儿气管镜检异物取出术麻醉中的应用

发布时间：2018-05-07 15:55

本文选题：右旋美托咪定 + 麻醉　；参考：《重庆医科大学学报》2017年05期

【摘要】：目的:探索右美托咪定在幼儿气管镜检异物取出术中的应用,观察右美托咪定对围术期患儿呼吸及循环功能的影响。方法:纳入2013年7月至2015年11月期间因气道异物拟行保留自主呼吸全身麻醉气管镜检异物取出术患儿80例,随机分为2组(n=40):右美托咪定组(D组)、对照组(C组)。所有患儿诱导均采用七氟烷,而后D组患儿采用右美托咪定复合瑞芬太尼靶控输注维持麻醉;C组患儿采用丙泊酚复合瑞芬太尼靶控输注维持麻醉,异物取出并撤出气管镜即停止药物输注。观察2组患儿麻醉诱导前(T0)、喉镜表面麻醉时(T1)、气管镜置入时(T2)、气管镜置入后5 min(T3)、气管镜撤出时(T4)、气管镜撤出后5min(T5)、患儿出PACU时(T6)的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)改变;观察2组患儿术中及术后屏气、呛咳、喉痉挛、呼吸抑制、低氧血症等发生率;记录患儿麻醉时间、手术时间及苏醒时间。结果:与T0相比,D组患儿术中时间点(T1~T4)HR、MAP及RR下降幅度低于C组,术中T1~T4时间点三者水平C组低于D组(P0.01);D组及C组患儿手术时间及麻醉时间组间差异无统计学意义[(22.35±4.50)min vs.(22.43±4.70)min],而D组苏醒时间长于C组,差异有统计学意义(21[16,25]min vs.13[11,15]min,P0.01);D组呼吸抑制(3/40)及低氧血症(1/40)发生率低于C组(12/40,7/40)(P0.01),其余不良反应发生率无统计学差异。结论:与丙泊酚相比,右美托咪定用于幼儿气管镜检异物取出术麻醉对呼吸及循环系统功能抑制作用较弱,减少术中呼吸抑制和低氧血症发生率,但可延长麻醉后苏醒时间。
[Abstract]:Objective: to investigate the effect of dexmetomidine on respiratory and circulatory function in infants undergoing tracheoscopy. Methods: from July 2013 to November 2015, 80 children with foreign body were randomly divided into two groups: dexmetomidine group (group D) and control group (group C). All children were induced by sevoflurane, and then group D was treated with dexmetomidine combined with remifentanil target controlled infusion maintenance anesthesia. Group C was treated with propofol combined with remifentanil target controlled infusion maintenance anesthesia. The foreign body was removed and removed from the tracheoscope. The heart rate (HRHRH), mean arterial pressure (MAPP) and respiratory frequency (RRR) were observed in the two groups before anesthesia induction, before laryngoscopic anesthesia, at T2, 5 min after tracheoscopy, 5 min after tracheoscopy withdrawal, 5 min after T5, 5 min after tracheoscope withdrawal, and 5 min after T6. The incidence of holding breath, choking cough, laryngeal spasm, respiratory inhibition and hypoxemia during and after operation were observed, and the time of anesthesia, operation and recovery were recorded. Results: compared with T0, HRMAP and RR in group D were lower than those in group C. The level of T1~T4 in group C was lower than that in group D (P 0.01). There was no significant difference in operation time and anesthesia time between group C and group D [22.35 卤4.50)min vs.(22.43 卤4.70)min], but the time of recovery in group D was longer than that in group C. The incidence of respiratory depression and hypoxemia in group D was significantly lower than that in group C (12 / 407 / 40 / 40), but there was no significant difference in the incidence of other adverse reactions. Conclusion: compared with propofol, dexmetomidine can inhibit respiratory and circulatory system function less, reduce the incidence of respiratory inhibition and hypoxemia, but prolong the recovery time after anesthesia.
【作者单位】：成都市妇女儿童中心医院麻醉科;
【分类号】：R726.1

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